Saturday, December 27, 2008

Destination: Heartbreak Hurricane Katrina-part 6

In 2004, Volusia County Florida was hit with back to back hurricanes. Charlie hit first and was a surprise visit. I had lived in this area for 26 years and it was the first time I had had to make the decision to get everyone out of bed and sleeping in the hallway. Morning came and with it, I found my neighborhood in complete disarray. Debris everywhere, roads impassable in places and to my complete shock no stores open, no gas stations open. No power. Neighbors were outside talking to each other--that was a shock because in suburbia-land no one talks to your neighbor. Who has time for such pleasantries? With no power, no air conditioning, no refrigerators, no phones, no TV, no jobs; we had all of the outdoors and plenty of time to get to know our neighbors. How were we suppose to know what the heck was going on? I told my youngest that we were camping in the house--we camped for 9 days. It became word of mouth communication--there would be a truck at the Winn Dixie giving out free water. There was a gas station open and we would all line up. It was a challenge--it gets mighty hot in the south without air conditioning or fans. I was lucky, my house withstood the winds and we had little rain so no flooding. Money became very tight but I didn't lose my job. I can't imagine the horror of Hurricane Katrina. Our County suffered from the hurricanes. Some houses didn't get repaired for over a year and some not at all. People lost jobs. We all lost alot of sleep and alot of money. But in comparison to Katrina, it was just the false labor of a difficult pregnancy.
For many people in the US, there is little understanding of the need to regulate and carefully control infant formula in times of emergencies. Why regulate it or control it? Without electricity and without access to clean water, infant formula, particularly powdered infant formula increases the risk of diarrheal diseases in babies with an increased risk of fatalities. Infant formula preparation in times of emergencies is enormously difficult to make safely. Mothers with newborn and young babies should be encouraged to breastfeed, especially exclusively breastfeed. But if these products are given out without discussion and understanding of the realities of disasters, then many more women will use these free products. What happens to these mothers and babies, when donations stop but the need is just as great for these free products? After the worst is over, money is often scarce (even for those of us who are prepared). Social services can be overwhelmed. So how does a mother feed her baby, when the free stuff stops (even on WIC, mothers will still have to buy some infant formula out of pocket).
Out of curiosity I scanned many, many articles on the internet trying to get an idea of how much infant formula was airlifted and trucked into shelters after Hurricane Katrina. Alot...alot and most of it distributed like bottled water. Nestle writes, "Although it is not our normal policy to donate infant formula, Nestle USA has donated a supply of ready-to-feed infant formula and Nestle promotional partner Munchkins Inc is donating baby bottles..." Nestle at least understood the necessity of "ready-to-feed" infant formula. Although not the danger of bottles--WHO organizations recommends cups because bottles are difficult to clean. One of our local WIC nutritionists use to always say to new WIC moms, "if you want ready-to-feed, breastfeed!!" (WIC does not normally provide ready-to-feed formulas). I ran across pictures from an organization called Compassionate Alliance in which they were trucking what appears to be powdered infant formula (along with food and water). Many churches, universities, and charities appealed for infant formula. How much went to shelters? Unknown. Mentioned were pallets of Ross ready to feed, Mead Johnson ready to feed. PBM Products (Bright Beginnings formulas and members mark brand formulas available in WalMart, Target, Publix, etc) contributed infant formula to Second Harvest (the largest domestic hunger-relief organization in USA). All ready-to feed because of the understanding of the limited availabilty of clean water. It was warehoused in Shreveport, Louisiana. March of Dimes mentions a collaboration with Mead Johnson in distributing ready to feed infant formula. Mead Johnson mentioned it shipped infant formula totaling more than $500,000 in value, 2 million bottles or cans of infant formula. GMA (Grocery Manufacturers of America) donated $10 million products including infant formula. PhRMA donated millions of cans of infant formula. Abbott donated 4.5 million in nutrition, medical and pharmaceutical products. Novartis donated $10.5 million in pharma and over the counter products including infant and baby and nutritional products. I even ran across an article that stated that Israel sent infant formula. The USDA sent a tractor trailor full of infant formula. It is difficult to get a good idea of how much infant formula was sent. How many babies needed the infant formula? How many actually got what they needed? How many new mothers or mothers with young babies might have breastfed their infants, if counseled about the risks of infant formula during emergencies? We are seeing rising rates of infant mortality in Louisiana. Those mortality rates are equivalent to or worse than some developing nations. But our nation still has the faith in infant formula. We will ship it and send it everywhere without regulation, given freely in times of disaster. Never seeming to recognize the disaster that follows, the morbidity and mortality of infants fed artificial milks. The free sample, the free product during a disaster serves a purpose in a market economy. Its a hook.....we are grateful to the companies that so kindly provide us with something for free. How kind of them. Of course we don't think about the tax write-off, nor how many people get hooked into having that free product. Like the free cigarettes given out to servicemen years ago, we aren't seeing the connections. We don't see the connections until it is too late. And some never see the connection because they can't picture reality without cigarettes.... or without infant formula.
Copyright 2008 Valerie W. McClain

Thursday, December 18, 2008

Destination: Heartbreak Hurricane Katrina-part 5

"You can't make me breastfeed!!!" The woman stood in the doorway of the WIC office shouting the words with defiance and anger. She had just walked in the doorway. We were stunned by her anger. I had never seen this woman before in my life and I wondered how she thought that we could make her breastfeed? How do you make women breastfeed? I certainly would like to see all women breastfeed their babies but making someone do it is beyond my belief system.
Yet, there are people in our society who believe that women should be made to breastfeed their babies. When I had a private practice as a lactation consultant, I had a client who upon hearing that I had one time been employed with WIC, said, "those people should be made to breastfeed." Of course, she wasn't actually breastfeeding. She was pumping and feeding her baby bottles of her milk. She felt she had to give her infant her breastmilk because her physician husband felt that his children deserved the best. But she didn't want to actually, physically put her baby to her breast. But she felt that those people who ask for help from the government should be made to breastfeed. I got the impression that she viewed breastfeeding at the breast as a punishment. And that punishment was suitable for "those" people who asked the government for help. All very astounding to me. I find it hard to view breastfeeding as punishment. I hope that all women and men are educated on the risks of artificial feeding. If after learning those risks, parents continue to make a choice for infant formula, so be it. I believe it is our society's duty to set that education in motion. Instead we have beaten around the bush because people are afraid. Afraid that their jobs are on the line, if they speak the truth. So instead the real issues are skirted, avoided. Melamine in formula in the US. Let's blow it under the table for another time, when it is safer to talk about it. Babies in NICUs dying from e. sakazakki from powdered formulas. Rare happenings? Not so, according to some lawyers looking for business. The rumblings about the safety of infant formula are kept under wraps by an industry that has its tentacles wrapped around many a human milk researcher. It also has its tentacles wrapped around various governmental agencies. How many tons of infant formula were sent to Louisiana by the USDA in the aftermath of Hurricane Katrina? And how many women in the time after the intitial impact of the hurricane, had such easy and free access to infant formula? But heck they were already trapped by their choice.
The choice of using an artificial milk for her infant, destroyed Tifanny Woods and Emmanuel Scott's family. Society scapegoats the victims, and goes on playing the game that breastfeeding is just a "lifestyle choice," without speaking one word about the risks of infant formula.
Copyright 2008 Valerie W. McClain

Wednesday, December 17, 2008

Destination: Heartbreak Hurricane Katrina-part 4

According to the Justice Policy Institute, "Louisiana has the highest per capita incarceration rate in the country with 814 per 100,000 people. Women are the fastest growing segment of the Louisiana prison population." Both Tiffany Woods and Emmanuel Scott got life terms in prison without parole. Emmanuel was sent to Angola Prison ("The Farm"). Angola was originally a plantation encompassing 18,000 acres that was farmed by slaves prior to the Civil War. It was turned into a prison and developed a reputation for being one of the most violent prisons in the US. Recent troubling events show that some prisoners have been given solitary confinement for over 30 years (Angola 3). Prisoners still work the farm like the former slaves-harvesting cotton, soy, etc.
About a month ago I contacted Tiffany Woods' and Emmanuel Scott's lawyer, Edward Mouton. He spoke about how this case bothered him. In a later email to me, he repeated his concern, "This case still causes me to lose sleep and feel great distress." He had just seen Emmanuel at Angola Prison, "Emmanuel will have only that surreal place to live out his life."
I found that the more questions I asked, the more questions I had regarding this situation. Tiffany had older children besides baby Emmanuel. It took 10 months after the baby's death, before they were charged in his death. They were not charged as being abusive to the older children.
What did the autopsy show? A malnourished baby. But sick infants become malnourished because of their illnesss. Tiffany said the baby was sick. Was there no signs of infection? We do know that cow's milk as well as infant formula can dehydrate an infant rapidly because of their high solute load. It is one of the risks of artificial baby milks that is not discussed often enough with mothers and fathers. Breastfeeding does not carry the same risk. Were these parents made aware of the risks of artificial baby milks? (Tiffany at one time was on WIC--WIC is suppose to promote breastfeeding)
What are the risks of infant formula? Parents need to know that infant formula or any substitute for breastfeeding/human milk carries an increased risk of disease and death. For instance, "Formula-fed infants in the US have a 10-fold risk of being hospitalized for any bacterial infectiona and a four-fold risk of bactermeia and meningitis. " In developed nations "formula-fed infants have a three to four-fold risk of diarrheal illness."
Walker, M. "A fresh Look at the Risks of Artificial Infant feeding," JHL 9(2):97-107 (1993)
According to the Humanitarian Exchange Magazine on infant feeding in emergencies in Lebanon.
"In terms of child survival breastfeeding is crucial: 13% of all under-5 deaths could be prevented if all infants were breastfed--more than any other preventative intervention."
"Moreover, during an emergency people may not be able obtain enough formula to feed their baby adequately because they are cut off from markets or because of cost."
In a document by the Department of Health of Louisiana dated December 9, 2005 regarding Hurricane Katrina and the challenge to health care, "The capacity for serving low-income and uninsured populations has been destroyed or significantly reduced in the affected areas....The Department is working diligently to establish primary care services for those who no longer have access to their normal medical facilities."
The Department of Health states that their capacity to serve the poor was destroyed or significantly reduced. Did Tiffany Woods and Emmanuel Scott refuse to access health care services for their infant as evacuees of New Orleans? Or was the health care services of Shreveport so overwhelmed (5000-30,000 evacuees from New Orleans housed in Shreveport) that this couple was one of the people that fell through the cracks? Two people are in prison for the rest of their lives. Justice? What lessons has a society learned? In an article in the New York Times by Eduardo Porter called "Katrina Begets a Baby Boom by Immigrants dated December 11, 2006, "...hundreds of babies are being born to Latino immigrant workers, both legal and illegal, who flocked to the city to toil on its reconstruction." The article is about women needing jobs, being pregnant, bottlefeeding their babies because they expect to go back to work right away.
And so onward we travel....destination heartbreak....when will we learn?
Copyright 2008 Valerie W. McClain

Saturday, December 13, 2008

Destination: Heartbreak Hurricane Katrina-part 3

photo by Jessie McClain
Louisiana justice system gave Tiffany Woods and Emmanuel Scott life imprison with no chance for parole. Ignorance of infant feeding and not accessing the medical system is no excuse in Louisiana. Although one might call this a "catch-22" system. Most Americans are ignorant of the dangers of feeding infant formula or other artificial milks to babies. But that is no excuse in a court of law--despite the fact that almost everyone else is as ignorant. Recently, I was talking to a mother who had her babies in the 70's. She told me that her one baby could not tolerate the infant formula, so she went to 2% cow's milk. Her baby survived and is an adult with her own children. It was her pediatrician's recommendation that she switch. But this was back in the 70's and we were ignorant then (even the pediatricians). This mother told me that this child she had in the 70's, as an adult has had severe allergic reactions to food--passing out and being hospitalized. No connection was made between how this baby of the 70's was fed and her allergic reactions as an adult. I have seen over the years a variety of interesting substances in baby bottles-coca cola, etc. So there is alot of ignorant people out in the world, who could potentially be judged to be abusive to their infants.
Tiffany Woods' baby, Emmanuel, was 3 pounds at birth. In the WIC Program, he would have been categorized as very low birth weight (VLBW) and considered at high risk for nutritional deficiency. According to the WIC manual on counseling protocol for premature/low birth weight babies, he would have been at "increased risk for 'failure-to-thrive' (FTT)" He would have been at increased risk for aversive feeding behaviors-disorganized or dysfunctional suck. Tiffany had an infant that was at high risk for failure-to-thrive. Was she able to access a health care system that had been swamped with evacuees? Did she refuse to get help or were any attempts made at accessing the health care system so difficult that she gave up?
I recently read a myspace blog dated 7/18/08 by a woman from Shreveport, Louisiana entitled, "Idiots with the WIC program." She talks about a woman who went to WIC (newborn baby, mother not working, father recently fired from job) to get assistance in obtaining formula. According to this blogger, the mother was told that she would have to wait 2 months until she could get assistance. So what will this mother do? Feed the infant cow's milk? Waterdown what formula she could buy? And if she does this and her infant dies, will she and the father be sent to prison? Who takes the responsibility for infant feeding tragedies? Should parents be responsible for their ignorance? Might one believe that in a just society, it is the community's responsibility? It would seem that the healthcare system in Shreveport is broken because of a storm named Katrina. How does a city's healthcare system survive the influx of thousands of people in need? How would any city cope with this problem?
Who should be made legally responsible for the rising infant mortality in the South? The court system of Shreveport has determined that individuals are responsible.
Copyright 2008 Valerie W. McClain

Friday, December 12, 2008

Destination: Heartbreak Hurricane Katrina-part 2

The Maternal Child Health Journal in 2007 had an article called,"Health Concerns of Women and Infants in Times of Natural Disasters: Lessons Learned from Hurricane Katrina."
"Natural disasters such as Hurricane Katrina can result in a substantial disruption of the public health and clinical infrastructures that are necessary for prenatal, intrapartum, and postpartum care. Women remaining in the affected area may need to find a new local source of care, and displaced women will need to find a provider in their new location. Access to existing prenatal care records may be limited, and referral of these women to new providers needs to occur quickly..."
In a letter written by the American Academy of Pediatrics, Louisiana Chapter to The Advocate in October 10, 2007, they say, ""However there are still pediatricians who refuse to accept Medicaid patients because of the less than adequate reimbursement and the fear that more cuts will be made. When the state had budget problems, Medicaid is a big target that is totally unprotected."
A recent news article from the Bradenton Herald in Florida (December3, 2008) entitled, "Baby almost dies from watered-down formula," states, "She [the mother or the baby that nearly died] said she was trying to stretch the allotment of baby formula cans she receives each month from the federal WIC program for low-income families......'WIC only gave me 8-10 cans a month, he goes through 15 cans...'" Baby LaDamian, 5 months old, survived and was expected to be released from the hospital in Tampa.
Tiffany Woods and Emmanuel Scott of Shreveport, unlike this recent Florida family, faced far more tragic consequences regarding their infant, Emmanuel. Tiffany and Emmanuel were from New Orleans, escaping Hurricane Katrina by evacuating to Shreveport. Their son had just been released from the hospital having been premature and only weighing 3 pounds at birth.
Tiffany, according to news articles, found him difficult to feed. [Many premature infants have feeding difficulties and are at risk for failure-to-thrive.] She stated in court testimony, according to one news article that she had run out of WIC and couldn't afford formula. She fed her son cow's milk instead of formula. At 5 months old in November of 2005, baby Emmanuel died. The cause according to a coroner's report was malnutrition and starvation. According to one news article, Tiffany said he was sick. Tiffany and Emmanuel were arrested and charged with the baby's death in September of 2006. In August of 2008, a judge found them guilty in the death of their son. (they declined a jury trial). They were sentenced in September of this year to life in prison for 2nd degree murder.
Supposedly during closing arguments, the Prosecutor said, "This baby didn't die in a hut in another nation, it died in a house in Shreveport, with a refrigerator that was full of beer and food." The couple was tried in a Caddo Parish courtroom in Shreveport, Louisiana. Caddo Parish has a documented black infant mortality rate of 32.7--similiar to some African nations.
The paradox of our land of plenty is that we spend more per capita on healthcare than any other nation in the world but our black infant mortality rate is closer to some developing nations.
The judge in this case did not believe Tiffany's testimony and found the autopsy picture shocking (all failure-to-thrive babies are shocking to look at). I find it disturbing that the autopsy pictures of baby Emmanuel can still be viewed on the internet.
I read many of the internet comments to this news event and was floored by the almost universal condemnation of this couple. I am not sure how we ever get to the truth of any given situation. Was Tiffany not telling the truth to the judge? Was the judge aware of the issues regarding evacuees (it has been estimated that over 5000 evacuees sheltered in Shreveport). How did the clinics in Shreveport, Medicaid and WIC, handle this massive influx of people? How overwhelmed were the families by the stress of evacuation and the lines and waiting? Would they have felt that there is no help, even when you ask for help? Why in Florida do we quickly believe that the white mother who nearly killed her baby by watering down the formula was just ignorant? But a black mother must have been negligent/murderous to give her infant cow's milk? How easy or difficult would it have been to see a pediatrician in Shreveport, if you were an evacuee without money, credit, or any paperwork? Wouldn't some people fall through the cracks? Questions and more questions.
Copyright 2008 Valerie W. McClain

Thursday, December 11, 2008

Destination: Heartbreak Hurricane Katrina, part 1

photo by Mariah McClain
How to begin a tale of trial and tribulation? Where does it start and when will it end? What do we believe to be true and how much of what we know is shrouded by the purveyor of reality, Tellyvision. Hurricane Katrina hit New Orleans in August 2005 and the tidalwave of this storm is still flooding communities near and far from its initial impact. Louisiana is one of the poorest states in the USA. Prior to Hurricane Katrina there was a high level of infant mortality, many social services were struggling for survival in the face of the needs of its community. But in New Orleans, despite the poverty, there was always a sense of community. A history of roots connecting a people to the land, to the delta, to each other. Hurricane Katrina destroyed not only homes and businesses but it scattered people hither and yon. Severing ties of generations. Families split apart and made to navigate their lives in unknown seas. Life became a waiting game: waiting for news, waiting for the bathroom, waiting for showers, waiting for food & water, waiting for jobs, waiting for doctors, waiting for medications....waiting, waiting, waiting. Shelter, what is that when it is not your home or your belongings? In a room full of strangers, some helping, some not and the clock ticking slowly, slowly. Safety? Safe from the floods, the winds, and the rain but safety is not just about shelter from mighty storms. Safety resides in governments understanding the needs of its people during times of emergencies. But most important, it is the preparation before the disasters that help a people cope with such an enormous life challenge.
Infant feeding in emergencies requires a great degree of understanding of the risks of artificial milks. Most Americans believe that infant formula is just as good as breastfeeding. They believe breastfeeding is probably better for the baby but it doesn't really matter how a baby is fed. Thus, in an emergency, the first thought is how to get infant formula into the area. Yes, babies must be fed. And a mother who is exclusively formula feeding her infant and goes through such a disaster will need access to infant formula. But she will also need access to clean water, refrigeration for storing the artificial milk, a stove to sterilize bottles and nipples. This mother will also need to be aware of how easily an infant can dehydrate when on artificial milks. Thus her need for quick and easy access to medical help is important. The heat and humidity in the South without air conditioning is hard to bear. Infants and the elderly maybe at greater risk for heat related problems. So keeping an infant hydrated in the midst of such a disaster is vital. Breastfeeding boosts the immune system of the baby, a natural vaccination against pathogens in the environment. Artificial milks do not do this. An infant fed artificial milk is at higher risk for diseases than a breastfed infant, particularly an exclusively breastfed infant. Therefore, the safety of bottlefed infants creates a bigger economic burden on the community, on the government. It seems that our institutions are willing to take on that economic burden without question. Safety of the next generation is a priority in any society. There is talk about preventative medicine--eating nutritious foods, exercise, fresh air, etc. Certainly breastfeeding is preventative medicine. The parents and the community save in a variety of ways-medically, environmentally. Dollars that would be spent on artificial milks can be spent on other items. Yet our communities, our institutions, our government are willing to pay the price of artificial feeding. But are parents really understanding of the price they can pay by feeding their babies artificial baby milks? It is parents who will have to bear the burden of a community unwilling or unable to educate its citizens about the risks of infant formula.
Is there a connection between artificial baby milks and infant mortality? There are studies that show a correlation between the two. In 2005, after Hurricane Katrina, the UN published a report on global inequality. Specifically mentioned was the "growing racial and economic divide in the USA." "America's black children are twice as likely as whites to die before their first birthday."
In a US & World report in June 2, 2007, they state that in the heart of the Mississippis Delta the black infant mortality rate is 17 per thousand. It was mentioned that there is a belief that this rise of black infant mortality rates in Mississippi is related to Hurricane Katrina. In Caddo Parish, (Shreveport)Louisiana the black infant mortality rate is 32.7. While much of infant mortality is caused by prematurity, low birth weight, SIDS, and birth defects. Consideration should be made regarding the lack of breastfeeding among the young, poor, and black women in the South.
In a policy statement by UNICEF called "INFANT AND YOUNG CHILD FEEDING IN EMERGENCIES" they state, "Even in the best, most hygienic conditions, artificially-fed babies are five times more likely to suffer diarrheal diseases, emergency situations artificially fed infants are more than 20 times more likely to die from diarrhea and other infectious diseases than infants who are exclusively breastfed." in regard to Indian Ocean Crisis--
Some might say that UNICEF was directing this at developing nations not the USA. But looking at the rising black infant mortality rates in the South, particularly in areas with large numbers of Katrina evacuees, one might say that it is time for our communities to rethink infant feeding practices in the USA.
Copyright 2008 Valerie W. McClain